Posted: Monday, December 1, 2025
Sustained marrow and imaging measurable residual disease (MRD) negativity after autologous stem cell transplant (ASCT) and 3 years of lenalidomide may suggest the possibility of safely discontinuing maintenance therapy in patients with multiple myeloma, according to Panagiotis Malandrakis, MD, of the National and Kapodistrian University of Athens, and colleagues. These findings from an updated report of a prospective cohort study were presented during the European Society for Medical Oncology (ESMO) Congress 2025 (Abstract 1242O).
The investigators focused on patients with newly diagnosed disease who underwent lenalidomide maintenance therapy after ASCT. Lenalidomide was discontinued in patients who had received at least 36 months of such maintenance therapy, achieved three consecutive bone marrow MRD-negative results, and had imaging MRD negativity by PET/CT; MRD was then assessed every 6 months thereafter. If testing showed a conversion from MRD negativity to positivity, lenalidomide was reinitiated.
A total of 54 patients achieved MRD negativity and discontinued lenalidomide. The median duration of follow-up from discontinuation was 41.3 months. The 1-, 2-, and 3-year landmark progression-free survival rates from discontinuation were 96.3%, 96.3%, and 93.9%, respectively. A 3-year treatment-free survival rate of 75.7% was reported. The treatment-free survival rate was 96.2% at 1 year and 89.9% at 2 years.
In patients who converted from MRD-negative to -positive status, the median time to MRD resurgence was 30.6 months. The 3-year landmark progression-free survival rate was 92.3% for those who experienced MRD resurgence. More than a quarter of patients (25.9%) who initially completed maintenance restarted lenalidomide monotherapy after converting from MRD negativity to positivity, of whom 7.4% experienced disease progression and received second-line treatment. The median follow-up from the reinitiation of lenalidomide was 13.4 months, and the median time to disease progression was 16 months from reinitiation. One patient who discontinued maintenance therapy died from multiple myeloma–unrelated causes.
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